MRI 5-24-04

Contrast MRI | Pre-OP Versus Post-OP | Fat Suppression MRI

Fourteen weeks status-post Micro-Discectomy: MRI w/ Gadolinium

Life was still 'sucking' following my Micro-D, so I opted for another MRI; only this time it was done with contrast enhancement (gadolinium). Contrast helps to visualize scare tissue (epidural fibrosis) and is frequently used following failed discectomies

During this MRI scan I used Los Gatos MRI's new 'Weight-Bearing Simulation System'. What they did is put me in a shoulder harness with straps connecting to a platform on which I stood. Once cinched up, they ratcheted me down to the platform. Then they slid me in the closed MRI tube. This compressed upon my spine and was supposed to simulate weight-bearing and exaggerate any disc bulging or herniating that may be present. Honestly, I felt more discomfort 'sitting' in the weighting room, than I did in the tube, although my both of my feet fell asleep from the pressure.

These are the over-head (axial) views the my L5 disc status-post surgery.

Fig.#1 represents my standard T1 weighted axial image. Note the scar tissue (epidural fibrosis) surrounding the left S1 nerve root (green arrows). You can't even tell where the nerve root is because of the scar tissue to the back and front. The right S1 root, on the other hand, is clearly visible (yellow arrow) and non-impinged.

Fig.#2 is a T1 weighted image with enhancement. They used Gadolinium for the contract medium which was injected intravenously about half way through the scan. Now we can see the darker left S1 nerve root without too much difficulty (red arrow). Note the swelling within the disc from the discectomy, especially in the posterior periphery of the anulus (black arrows). One thing is for certain: that small contained disc herniation is long-gone and my left S1 root is no longer being contacted. (Too bad my leg pains continue! Another case where the compression is relieved but the sciatica remains.)

I've thrown in the Pre-operative MRI from 2-04 for comparison purposes (figure #3). Fig.#3 is a T2 weighted image (thecal sac is white) that depicts a small left paracentral herniation that touches the left S1 root. Compare figure #3 with Figure #5; you can see the herniation is gone; however, a moderate sized disc bulging remains. The left root (which looks atrophied) has a good 3 mm of clearance from the back of the disc.

Finally, I would like to share my Post-Op lateral with you. Figure #6, represents a 'Fat Suppression' MRI image which really lights-up anular tears. Note the large and deep anular disc tear at the L4 level (pink arrow). This may be leaking degenerated nuclear material from my L4 disc, hence the L4 and L5 radiculopathy.

Also note the swelling within the post-op L5 disc (white arrow).

There are no herniations in this view as the 'super' white thecal sac shows no indentations.

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